ENRIQUEZ, Angelique Jade C.

BSN 2 C4

DRUG STUDY
Generic Name:Oxytocin
Brand Name: Pitocin, Syntocinon
Classification: Uterine-active agents

Availability  
5 units;10 units/mL injection in 1ml ampule,vial or syringe in compatible IV solution.

Action

 As for endogenous oxytocin,but with little vasopressin activity

 Stimulates uterine contraction
 Stimulates lactating breast to eject milk
Therapeutic effects
By direct action on myofibrils, produces phasic contractions characteristic of normal
delivery. Promotes milk ejection (letdown) reflex in nursing mother, thereby increasing
flow (not volume) of milk; also facilitates flow of milk during period of breast
engorgement. Uterine sensitivity to oxytocin increases during gestation period and
peaks sharply before parturition. Not used for elective induction of labor.

Use
Induction and maintenance of labour
Controlling postpartum bleeding and uterine hypotonicity in the third stage of labour

Dose
(Induction of labour) initially 1-4 mU/minute= 2-8 drops/minute by IV infusion,
increasing at intervals of at least 20 minutes(to a maximum of 20 mU/minutes) until
constractions are similar to normal labour OR
(Management of third stage of labour or postpartum haemorrhage) 5-10 IU IM or 5 IU
slowly IV OR
Contraindication
Hypersensitive to drug when vaginal delivery is advised
Cephalopelvic disproportion is present
When delivery requires conversion as in tranverse lie

Adverse Effects
CV:Hypertention,increase heart rate,systemic venous returns,cardiac output
GI:Nausea and Vomiting
Repiratory:Anoxia,Asphyxia
Others:Low APGAR score at 5 mins.

Nursing implications 

Assessment & Drug Effects

 Start flow charts to record maternal BP and other vital signs, I&O ratio,
weight, strength, duration, and frequency of contractions, as well as fetal
heart tone and rate, before instituting treatment.
 Monitor fetal heart rate and maternal BP and pulse at least q15min during
infusion period; evaluate tonus of myometrium during and between
contractions and record on flow chart. Report change in rate and rhythm
immediately. Stop infusion to prevent fetal anoxia, turn patient on her side,
and notify physician if contractions are prolonged (occurring at less than 2-
min intervals) and if monitor records contractions about 50 mm Hg or if
contractions last 90 seconds or longer. Stimulation will wane rapidly within 2–
3 min. Oxygen administration may be necessary.
 If local or regional (caudal, spinal) anesthesia is being given to the patient
receiving oxytocin, be alert to the possibility of hypertensive crisis (sudden
intense occipital headache, palpitation, marked hypertension, stiff neck,
nausea, vomiting, sweating, fever, photophobia, dilated pupils, bradycardia or
tachycardia, constricting chest pain).
 Monitor I&O during labor. If patient is receiving drug by prolonged IV infusion,
watch for symptoms of water intoxication (drowsiness, listlessness, headache,
confusion, anuria, weight gain). Report changes in alertness and orientation
and changes in I&O ratio (i.e., marked decrease in output with excessive
intake).
  Check fundus frequently during the first few postpartum hours and several
times daily thereafter.
 Incidence of hypersensitivity or allergic reactions is higher when oxytocin is
given by IM or IV injection rather than by IV infusion (diluted solution).
 Patient & Family Education.
Patient & Family Education

 Be aware of purpose and anticipated effect of oxytocin.

 Report sudden, severe headache immediately to healthcare providers.

Generic Name: Methergine Methylergonovine Maleate

Brand name: Ergon, Mergot
Pharmacologic: ergot alkaloids

Availability Tablets:200 mcg (0.2 mg).

Injection: 200 mcg (0.2 mg)/ml in 1-ml ampules.

Action
Methylergonovine maleate (methergine) is an ergot alkaloid that stimulate smooth
muscle tissue. Because the smooth muscle of the uterus is especially sensitive to this
drug ,it is used postpartally to stimulate the uterus to contract in order to decrease
blood loss by clamping off uterine blood vessels and to promote the involution
process .In addition the drug has vasoconstrictive effect on all blood vessels, especially
the larger arteries.
Route, Dosage, Frequency
Methergine has a rapid onset of action and may be given orally or intramuscularly.
Usually IM dose: 0.2 mg following expulsion of the placenta.The dose may be
repeated every 2-4 hours if necessary.
Usual oral dose: 0.2 mg every 4 hours (six doses)

Maternal Contraindications
Pregnancy, hepatic or renal disease, cardiac disease, hypertension or preeclampsia
contraindicate this drugs use. Methylergonovine maleate must be used with caution
during lactation.

Maternal Side Effects

Hypertension, nausea, vomiting, headache, brandycardia, dizziness, tinnitus, abdominal
cramps, palpitations, dyspnea, chest pain and allergic reactions may be noted.

Nursing Implications

 Monitor fundal height and consistency and the amount and character of the
lochia.
 Assess the blood pressure before and routinely throughout drug
administration.
 Observe for adverse effects or symptoms of ergot toxicity(ergotism) such as
nausea and vomiting, headache, muscle pain, cold or numb fingers and toes,
chest pain and general weakness.
Patient /Family Teaching

 Instruct patient to take medication as directed; do not skip or double up on

missed doses. If a dose is missed, omit it and return to regular dose schedule.
 Advise patient that medication may cause menstrual-like cramps
 Caution patient to avoid smoking, because nicotine constricts blood vessels.
 Instruct patient to notify health care professional if infection develops, as this
may cause increased sensitivity to the medication.